Healthcare Provider Details

I. General information

NPI: 1568643161
Provider Name (Legal Business Name): VICTORY VISION CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2007
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ATLANTIC AVE
BROOKLYN NY
11217-1913
US

IV. Provider business mailing address

565 ATLANTIC AVE
BROOKLYN NY
11217-1913
US

V. Phone/Fax

Practice location:
  • Phone: 718-622-2020
  • Fax: 718-622-5404
Mailing address:
  • Phone: 718-622-2020
  • Fax: 718-622-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number006618-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number006618-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number006618-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number008716
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number008716-1
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number006618-1
License Number StateNY

VIII. Authorized Official

Name: LYUBOMYRA KOLESNYK
Title or Position: OWNER
Credential:
Phone: 718-622-2020